Finding a good DME?

[sawinglogz]

(Moving to its own thread)

It turns out my insurance provider works with more than just a single DME, which is a relief.

The representative said that they have a network of approved providers. She mentioned Lincare and Apria as the biggest. My sleep doctor mentioned Reliable. The rep was reluctant to list off all the providers (I'm guessing it's a long list), but was happy to answer specific questions. (I mentioned the doctor's recommendation of Reliable, and she immediately said they were on the list.) I'm going to ask for a fax of the DME list today.

So since it turns out I have a choice in all this, do people have any DME recommendations (pro or con), or any tips on what I should look for or how I would find a good one? (My understanding is that this board's sponsor isn't in any insurance provider's network.)

I know Apria gets a lot of hate on this board, but it wasn't clear to me exactly why, or whether the problems were regional or nation-wide.

[Janknitz]

We call Apria "Crapria" for a reason, but you may be lucky with an individual office (that is becoming harder to do because the phone numbers connect you to call in centers where you never get personal service). Same with Lincare.

Your best bet is to ask your doctor for the prescription for the exact machine you want (see my blog post below--"What you need to know BEFORE you meet your DME"), DO YOUR HOMEWORK with your insurer so you understand your coverage, and then "let your fingers do the walking".

Start calling the in network DME's and ask:

1. My doctor has prescribed the ___(make and MODEL)______ machine, can your company fill this prescription as written with my insurance at no extra cost? The right answer is: "Sure, we have them in stock, bring in your prescription and we'll set you up."
2. What is your mask return policy? The right answer is: " We want you to be able to sleep comfortably in a mask so we'll work with you until you find the right one."

Ideally you will get at least two DME's with the right answers. The reason you want two is that one is probably lying. So when you get to DME #1, if they set you up, you're fine, but if they have "set you up" by getting you in there and then tell you why they can't fulfill the order as written (no range of pressures for an APAP, your insurance won't cover it, etc.), you have a fall back. You will say "Thanks, but no thanks. #2 DME said that they can fill the order as written. See ya!"

[sawinglogz]

I'm going to ask for a fax of the DME list today.

For some reason, it seems incredibly difficult for them to answer this. The woman I talked to mentioned Apria and Lincare, and when I asked about Reliable, she immediately said "yes". The man I talked to today spent a few minutes looking it up, and he said just the two national vendors (Apria and Lincare) and only one local DME. I asked about the entire metro area, and he said it was just that one.

Am I asking the wrong question? (I asked for the list of contracted vendors for providing CPAP machines and service.) How do you get this information out of your insurer?

[sawinglogz]

Thanks, Janknitz,

So, if I understand correctly, the big concerns are:

0. Getting ahold of someone on the phone.

1. Not providing the specified machine. (Common excuses might include not having it in stock, insurance not covering it, some alleged defect in the prescription that prevents them from fulfilling it as written, or "it's just the same" like Escape Auto vs. Autoset.)

2. Not providing a mask that works for me. (It sounds like mask fit is very subjective, and some DMEs don't want to exert the effort to deal with the returns.)

My insurer did say that oxygen and respiratory equipment and supplies are fully covered without deductible, and that they don't allow their vendors to balance bill. Does that affect anything I should do?

Also, I don't (yet) have the prescription, so when should I call the DMEs?

[Janknitz]

So, if I understand correctly, the big concerns are:

0. Getting ahold of someone on the phone.

1. Not providing the specified machine. (Common excuses might include not having it in stock, insurance not covering it, some alleged defect in the prescription that prevents them from fulfilling it as written, or "it's just the same" like Escape Auto vs. Autoset.)

2. Not providing a mask that works for me. (It sounds like mask fit is very subjective, and some DMEs don't want to exert the effort to deal with the returns.)

You've got it in a nutshell!
Good, sounds like you did your research with the insurance companies, so the DME's can't play "your insurance doesn't cover that" games with you.

Ask your insurance company for a list of preferred DME providers in your area. They should be able to provide that. If not, bump it up to a supervisor to ask.

Ask your doctor to write the prescription for the machine YOU want. The prescription should include the specific make and model you would like, it helps for the script to say "dispense as written" and "mask of patient's choice" .

Even without the prescription in hand, you can start calling the DME's once you know which machine you want. You will get a feel for how they roll. Be sure to ask the doctor to give YOU the prescription, and you will deliver it to the DME of your choice. Then you will make a copy and know exactly what the prescription says, so no DME funny business with that.

[LSAT]

From my experience with Apria....The biggest problem was with shipping the wrong product and billing problems. The individual offices will vary based upon the attitude and experience of the RTs. Best to go face to face if possible and talk to the personnel.

[Sheriff Buford]

DME's are necessary for us to get our equipment. Lots of folks hate cops, but they don't call the pizza delivery man when someone is assaulting them. Same way with DME's. If you depend on one actually helping you, you will run into a boat-load of trouble and disappointment. If you tell them what you want, you may be able to find one that will do only that. In fact, "just getting you your stuff" is probably all they want to do anyway. Sorry I'm not much help, but lower your expectations can make your unpleasant experience more tolerable.

Sheriff

[Sheriff Buford]

From my experience with Apria....The biggest problem was with shipping the wrong product and billing problems. The individual offices will vary based upon the attitude and experience of the RTs. Best to go face to face if possible and talk to the personnel.

I use Apria.... and when I order from them... I tell them to send the "exact stuff" they sent me 3 months ago. Sorta hard to mess that up. The only problem is that they keep sending me a replacement humidifier tub. I told them to stop sending me them because I don't use my humidifier... they never got the message... and the tubs are starting to pile up...

Sheriff

[porete]

DME's are necessary for us to get our equipment. Lots of folks hate cops, but they don't call the pizza delivery man when someone is assaulting them. Same way with DME's. If you depend on one actually helping you, you will run into a boat-load of trouble and disappointment. If you tell them what you want, you may be able to find one that will do only that. In fact, "just getting you your stuff" is probably all they want to do anyway. Sorry I'm not much help, but lower your expectations can make your unpleasant experience more tolerable.

Sheriff

I would agree with Sheriff, my DME is not extremely knowledgeable, but they are very willing to order whatever I need. I just have to do most of the footwork myself...making sure items are covered under insurance, compatibility with machine, etc. It is very important to be as self-educated as possible when dealing with a DME, sometimes they think something isn't covered under insurance, or they think the replacement schedule is different than what it actually is. If you have paperwork in hand and all your ducks in a row it will go much smoother.

BTW, Sheriff, my Dad is a retired intensive probation parole officer (carries weapon). I don't think I ever heard of anyone who was glad to see him either.

[sawinglogz]

Good, sounds like you did your research with the insurance companies, so the DME's can't play "your insurance doesn't cover that" games with you.

Ask your insurance company for a list of preferred DME providers in your area. They should be able to provide that. If not, bump it up to a supervisor to ask.

For some reason, it seems incredibly difficult for them to answer this. The woman I first talked to mentioned Apria and Lincare, and when I asked about Reliable, she immediately said "yes". The man I talked to yesterday spent a few minutes looking it up, and he said just the two national vendors (Apria and Lincare) and only one local DME. I asked about the entire metro area, and he said it was just that one. I don't feel like they're refusing to answer the question, it just seems like there's genuine confusion on their part.

Am I asking the wrong questions? (I asked for the list of contracted vendors for providing CPAP machines and service.) How do you get this information out of your insurer?

(I also never got an answer as to whether they pay a DME the same amount for all E0601.)

[Sheriff Buford]

If you have an HMO... the insurance company will tell you who they'll accept. If it is not an HMO, the DME will tell you if they accept your insurance. The DME wants to make money... they will tell you if they take your insurance or not. Looks as you are a "take charge" type of person. This is great! And will help you thru the issues of your therapy...

Sheriff

[SleepWellCPAP]

Hello All,

All these suggestions and posts are excellent!

One thing I might add, is that when you do get a company on the phone, ask to speak to the person who handles the CPAPs. When they answer, say something like the following: "My doctor has ordered a CPAP, can you tell me just briefly what that is and why it's so important for me to get one?"

The answer to that question is going to reveal how much they know and how far they will go to help someone. If you asked me that question, for purpose of comparison, my answer will go between 5 and 15 minutes.

Hope that helps.

Jim

[sawinglogz]

If you have an HMO... the insurance company will tell you who they'll accept.

You would think so, but both reps I talked to had trouble giving me a list. The first didn't want to look it up, and the second seemed to produce an incomplete list. Any ideas?

One thing I might add, is that when you do get a company on the phone, ask to speak to the person who handles the CPAPs. When they answer, say something like the following: "My doctor has ordered a CPAP, can you tell me just briefly what that is and why it's so important for me to get one?"

That's a great idea! But then how would you (or they) react when it's clear that I already knew the answer to that question (based on my request for specific equipment and requirements)?

[Wulfman...]

See if your insurance provider will reimburse you for out-of-pocket purchases (like if you buy from an online seller like CPAP(dot)COM).
That's what I did (eight years ago) and my insurance provider reimbursed me at their standard "in-network" rate of 80%. I purchased all of my initial equipment setup out-of-pocket (credit card) and then made out an invoice (duplicating CPAP(dot)COM's invoice) and sent it to my insurance provider......and they sent me a check for it. It saved both of us some money.......and, most people are looking to save money these days.


Den

.

[SleepWellCPAP]

Hello sawinglogz,

Good question!

I reckon you may have to play naive and not let them know you are aware. If it were me, I would just let them rattle on. You having the knowledge you do will work in your favor for sure.

Jim